Means for instructing by histophonetics



E- 1943- r E. l. SCHINDLER 2,328,169

MEANS FOR INSTRUCTING BY HISTOPHONETICS I Filed Mag. 1, 1940 2W Jag;

ATTORN S.

I and fibrillation.

strength of the the cardiac cycle.

I terferingi with the smooth, s

. movement of the coveringtof the normal soundresults commonl L thefrictionrubv c) When an plet of the heart n orfirst. sound alld thfildlElStQliOgOl secondsoundzj ABNORMAL HEAR'I SouNDs out above are disturbedasfollows: I

1. Disturbance in Tate.When,'the rate per minute is increasedqor decreased above or below theaveragewe have a condition classified as rate abnormality and when fast; receives the term tachycardia and when slow, receives the term bradycardia. r

. 2. Disturbance of rhythm -When the normal sequence of sounds in each cycle is disturbed, itI is spoken of as arrhythmia as a general term,

with many subdivisions, depending upon the disordered arrangement of the relationship of sounds and silence in each, heart cycle. Il1ustrations of such arrhythmias are found in the I terms phasic arrhythmia, premature beats 3. Abnormalities of character pressure; low blood pressure, enlarging of the heart duefto increased or' decre'ased strength ofthe heart muscle as in dilatation.

4. Abnowncl mechdnism.-(a) When thei mus- I cularfactoris markedly altered as in profound weakness or enlarging of the heart mass, there isan alteration V in the'sounds of the heart.

(b) Whenthe valves Within the-heart or im mediately outside the heart in the great-vessels become diseased or the "valve orifices dilated,

- abnormal sounds are produced,commonly called murmurs, and have a definite time relation in the heartis dilati wherein V v n the chambersjiaie widenediproduce anabnormalsound {(dl'VIhen disease of inflammation erased;

erin'g oflthe heart, the .pericardiumjfloccurs, in-

ilent, frictionless heart, an abforamen ovale ordeficient septum) or between the great vessels immediately outside, the heart :(as patent ductusarteriosus), abnormal sounds are produced of v a -characteristic nature.

The normal and abnormal heart ;soun'ds noted 1 *above'and. others} too numerous to illustrate *I have been able such away as to-give to 'recrea'teby sound effects in the impression to thehear: ing brain of'the actual :normal and abnormal heart soundsof the body." 'i k 5 Normal heart sounds with volumejcriction phasic}? commonly designated the rhythmic cone and referred tonas the systolic 1 With ,cardiophonetics; this diiference. in the ,quality of'thei-syst'olic and diastolic sounds as I 7 be clearly demonstrated with gratifying reproduction of thenormal.

' At thebase'of the heart'in l'llOSjiiIlStQllCSiWf-Z heard at the apex can hear with our stethoscope the diastolic sound mal characteristics in applying his stethoscope;

. of 5 heart A s0unds.'-'The pitch of the; heart sounds "and their intensity may beincreased or decreased as; in cases of high blood heartmuscle asin hypertrophy -(c) Therush of blood intothe ctmbejigt a;

eferred. to as I I abnormal iohcning devel opsin the'partitions of the heart chambers, fins patent I 1 Usuallytheheart soundsare heard as di-II a a conditions the nofmarifacto-r's V atthe base, as normally heard in early ChlldllOOd when the pulmonary is accentuated over the aortic and in' declining years when the reverse 5 is true, we have a valuable aid in cardiophonetics in bringing the sound characteristics of these age groups to thehearing mind of any size'audience without the necessity of having to' depend onindividual clinical material.-

' Fetal heart sounds It is highly instructive to have-in cardiopho netics a means of demonstrating the sound-in contrast to thematernal heart sounds.

maternalheart'sounds and rhythm o f a rate of approximately 75 per minute with its clarity of tone as heard over'the precordium, and then offer. I

fetal heart sounds as heard I n I wallasremote andfaint, I resembling somewhat; the ticking or a watchfbe-' I the much more rapid 20 through the abdominal ew e i l 'W-i" I I ljils tu r bances oj rhythm 1 Respiratory "phdsz'c -a'rrhythmz'a have a transitory acceleration of heart rate dur found in the averagedultwhere asustained breath usually: slowsthe heart'. -'=With cardio- I phonetics, I introduce the normal rate-and thenshow how during inspiration it becomesaccelerated and slows down again to the startingrate with expiration. r. I I Prematureibeats or systolcsIe This is the most common disturbance 1 of vrhythm brevity we will use the term condition the abnormal c V prematurely and 'mayarise'fromf'anirritable I focus in auricle ventricle orijunctional tissue;

I begin'by demonstrating'the sphyg mic'or pulse} j characteristics ofpresystoles'in which;by intro-i: ducing a. few regular b.eats;,I'I 'show"how then presphygmia occurs; by bringing these :twobeatsi tics. First, I have presystole with. omission iot jthe'fldia'stolic sound ofsemilunar closure. Here" we may-say that we'havethree sounds grouped togethenfollowed by aicompen'satory pause, the

fi-rstitwo sounds representing the normal cardiac 'couplet followed by the presystole with dropped 'semilunarclosurei The presystole comes as an unexpected premature-soundythat. is thrown in. bold relief bylthe:: compensatory pause, when prolonged silenceiu'sh'ers in the subsequent normal cardiac cycleiz in the second type of pre-T systole we have the presence Y of the *diastdlic sound of semilunar' closure and theeargets the impression arise, as auricle, ventricle orjunctionall tissue. I I 3. Sinus tdchycaTd-iaE- In."this"'conditionflw fetal heart VI 7 This maybe readily demonstrated by giving the I V {-In this condition, so common in childhood normally, we"

I ing inspirationwhichis the. opposite ordinarily close together, followed by thei compensatory"- pause. Then by demonstrating the normal car: 'Ldiac cycleyflead'up to the presystolegin which 7 I may have onezor the other of two characteris-l I of a r pingof four-sounds;the first two being the normal -'c'ardiacfcycle followed r I by-the premature two sounds.difzthepresystole II L l w i'ih C tory palle'ii lhe elec I .troc'amdiog"ram depended upon to I revealt-he I :irritablefocus'frorn whichthe 'presystole may have an acceleration of rate from approximately ,7

minute with thefsite r imI-f pulse initiation'in the pacemaker (sinoauricu- I I start the deirmnstration and lee-I ately precedes the this micro-phone is for collarv i l which "A fset. screw works up to it and isterminatedby'the advent first sound ofsystole and 1 of systole and has somewhat of a purring qual ity. With'cardiophonetics, I introduce the'ncrmal heart sounds to impress the'hearing mind withits rhythm, rate and quality and then introduce the murmur at the close of the diastolic period of silence, immediatelypreceding systole and terminated by it I5. Congenital murmurs-Here we have a continuous" abnormalfs ound usually with systolic accentuationfl Bymeans of. cardiophonetics, I

start-the demonstrationwith thenormal heart sounds :as a'baclrground and then introduce the 7 continuous murmur, which isv striking and char-. acteristic in that there jis' usually no silent pe:

riod. l

Further objects, [advantages and capabilities willlatenmorefully appear or are inherent in the novel means. V.

fInthe drawing: 7

Fig. 2 isafview in perspective of a microphone and the novel'cylinder,and tubing for permitting the instructor 'orloperator to-,blow into the cylinder to simulate certain sounds or murmurs.

' Fig. 3 is aviewflin perspective showingthe manner. of holding the cylinder and microphone with the hand positioned to simulate the desired sounds.

Fig, 4 1s a View in. perspectiveof the ,mouth- I piece adjusted foroperation.

Fig. '5 is a perspective View showing the man .nerof holding the microphone when the cyliner is not emplo'yed. I v Referring more particularly to thenovel means disclosed the drawin the invention comprehendsthe usev of a microphone-amplifie speaker systemiwhereby the simulated or imitated sound effects may be .carriedto a listening Theillustrative embodiment com- 2 to any desired number of loud speakers 3 suitably located at convenient places inthe room or hall so that the simulated sound effects may beamplified andtransmitted tea I listening audience.

' In. the recreation of the microphone may be enclosed within a cylinand B. The barrel or body *of the cylinder is per' forated at 1, and slotted adjacent one-end thereof at 8 to receive thecord inserted I in this slottedend with its sensitive s de or operative face proj ect-' ing .into the cylinder, Thus the microphone is held'in fixed :relationby thei cord and the end cap 5. The opposite end ;cap Bis provided- 'with a; centrally 'arrangedopeningand a nut or the 1 like Iii-located oneach sideofthe cap, theinuts having ,openings concentric With the opening in the'cap and in which isinserteda metal sleeve I 7 provides a bearing for, a metal tube lg, to the outer end of which is connected at piece of'flexible tubing l3 having a mouthpiece A of glass. or otherfsuitablematerial, The tubelZ is slidable in the collar or v I v ward movement islimited by astop member units inner end and by the shoulder orabutment i5 formed by the flexible tubingv at-its outer end. 7 t t It is provided in the'collar or sleeve ll to lock the tubeat'the desired adjustment;

The'cup'ped left hand serves as a resonator Fig. '1 is a'view in perspective of myfequipmnt' thedesired sound effects,

90f the microphone I and sleeve H butits oute the palm of the hand,

simulating the J thoracic cage; the bones of the hand separated by ;muscle, skin; fascia, etcz, analogous'to the'ribs and soft tissues of the chest.- n

usually the index, middle and ring fingers are useolas a plexor. to strike upon the dorsum of the cupped left hand The fingers of the right hand L8,

or dorsum of the wrist or drosum of the forearm; these latter serving as 'the pleximeter. In preparing for the demonstration of cardio phonetics operator, w o'must be an individual well versed in' normal sounds, holds, the micro-phone over'his own heart to test the working, of the amplifier system and to get the pitch and quality'of tone of the'heart sounds With its rhythm in his own mind and to peak the attention ofthe audience, acquainting them with what to expect. Then thefmicrophone l is placed in the cylinder lat the microphone cap end with the pick up side projecting into the lumen of the cylinder and the back resting against the cap 5 with the cord 'fittingjinto the slot and fastened down'to keep the microphone in a fixed position. The cylinder is placed in the cupped left hand in such a way as toallow the left fingers to loosely hold the barrel of the cylin der, so that the microphone cap does not contact between the cap and the skin surface to further accentuate the left cupped hand as a resonator.

The holes I in the cylinder are usuallyfree from finger tips'fordemonstration'of normal heart sounds'arid disturbances of rhythm.

V The flexible cord and mouthpiece attached. to

. audience or lecture hall from a lecture platform or by radio. prisesa microphone, I connected through an r amplifier unit drical member 4 having removable end caps 5 v heart condition to be reproduced.

the-dorsum of the right hand, 7 testing out the. interosseous spaces and the his teeth and blows tone can be found. I l he'interspace the stem cap serve to recreate heart murmursby the operator'who holds the mouthpiece-A between air into the interior of "the cylinden'impressing the sound on the sensitive pick-up surface of the microphone.- The pitch of the sound representing the heart murmurs may be changed by sliding the tube back and forth in the cylinder, the highest pitch of sound being obtained when the tube is fully inserted into the cylinder and the lowest pitch'when i'tfisi fully withdrawn. Y

A simplified method is 'to di'spense with as and hold the. rnicro-v phone, without any covering, in .th i-palm ofthe" microphone attachment hand and ,proceed'as' before; In this simplified method murmurs are'reproduced by blowing the breath directly into the cupped-left hand through approximating the a narrow opening, formed by ends of the thumb and index fingers.-

- The fingers of the right hand,'usually the index, -middle orring finger, are used as a plexor, striking the proper point on ,thedorsum of the-left hand, Wrist or forearm, in such a rhythmic pattern. so as to reproduce the rate, pitch; intensity,

rhythm and quality'of the normal-or Ihave found by tapping alon theleft hand with the fingers of metacarpal bones, 'fairlyclose to the knuckles (metacarpo-phalangealjunction),

middle and ring fingers of location to contact withthe ringlfinger of the right hand as theplexorjto portray the first,

heart sound, with its combined muscular and valvular quality.

7 7 its purely valvular quality is reproduced nicely by striking with the index finger. of the right-hand on the dorsum .of the summit offthe second metacarpophalangeal articulation' of thelleft f hand.

Either sound can b madelloud soft, short and "abnormal heart but allows a varying space abnormal the correct; between the the left hand is a good The second' heart soundwith i i two or three strokes of the plexor upon the pleximeter ,with properly spaced pauses, any desired cardiac cycle can, be recreated. The rate of the cardiac cycle and the rhythm can be. varied by the operator according tothe condition h wishes to reproduce. ,By using the'index and middle forearm with the interosseous 'spaceand either bone of l the forearm, serves admirably to reproduce certain types of heart sounds.

In reproducingthe common heart murmurs the stem end is fastened to the end of the cylinder opposite to the microphone and the mouthpiece at the distalend of the flexible tube held between thelips. The fingers ofthe right hand are used on thedorsum of the left hand tomaintain the prolonged with striking fidelity ofton'e to reproduce the, normal heart sounds. By introducing fingers of the right handon the dorsum of the wrist, with gentle strokes, the weak sounds of thefetal heart can bereproduced with its more ,7 7 rapid rate.y=,'1"henagain the dorsum of the left ery cloth or suitable roughened surface and rub this roughened surface againstthe front of the chest, timing it with the normal or abnormal cardiac cycle, introduced by tapping with the fingers of the right hand on the dorsum of the 3 l' left hand. V

Similarly, the sounds evidencing the various diseased conditions ofthe lungs and other organs may be recreated.

In simulating the sound of the pleura in various diseased conditions, a piece of sandpaper is rubbed close to the microphone with varying derate and rhythm, whetheri normal or abnormal to be reproduced, and the breath is blown through the tube, striking the surface of the microphone inside the cylinderwith sufficient force to reproduce, with startling fidelity, the sound of the common murmurs. Byvaryingthe force of the breath and the amount of air injected, and regulating the holes on thecylinder, and the use of the adiustablesliding tube into the cylinder, the exact quality of the murmur to be reproduced can be recreated, whether high pitched,'sharp, low pitched, soft, short or long and the. timing is synchronized with the heart sounds reproduced, ,by tapping on the dorsum of the'hand, forearm or wrist. Thusthe common murmurs,systolic in time diastolic, presystolic, middiastolic, continuous many other, can be accurately and faithfully reproduced; These murmurscan veil the imitatedheart sounds as an impurityor replace them entirely. .They can be combined with nor,-

mal or abnormal rhythm.

The friction sounds of the pericardium are reproduced as follows: I detach the cylinder from y the microphone, end and holdthe microphone in l the, palm of the left hand. I fasten to finger tips of left hand sandpaper, emerycioth or any other suitable roughened surface. By tapping with the cardiovascular and respiratory system by recreating and simulating the normal and abnormal finger tips of the right handon the dorsum of the p, it

cylinder with the microphoneend in the cupped left hand, remove the stem end and cover the opened end of the cylinder with sandpaper. em:

greesof forceto give the sound of the. rasping of the lung tissue against the pleura or lining of thechest cavity. s 7

It will be evident by this novel method of simulation and lecturing, and the means of practical demonstration, I am able to recreate sounds,

' and thereby I am able to more effectively demonstrate to a student body or audience ,than were each to use a stethoscope and examine a diseased body, or were the actual diseased condition amplified by an electrical system. In order to facilitate concentration, good results have been secured v by screening the operator and all of the equipment except the loud speakers from view and the room or lecture hall is darkened to eliminate visual distraction.

Having thus disclosed the invention, I claim: 1. Means forinstructing on the diseases of the heart sounds without the use of clinical material, comprising a microphone-amplifier-speaker system, a housingfor encompassing the microphone,

openingsprovided in the housing adjacent the pick-up side of the microphonegand tubing leading into the housing and adjacent the pick-up side of the microphone, said tubing being adapted to be blown into to simulate the sound of heart murmurs.

2. Means for instructing on the diseases of the cardiovascular and respiratory system by recreating and simulating th normal and abnormal heart sounds without the use of clinical material,

comprising a microphoneeamplifier-speaker system, and a hollow, perforated member surrounde ing th microphone and adapted to be held in the cupped hand of the instructor with thehand forming a resonator whereby tapping on the back m of the cupped hand, wrist or forearm is transmitted through the microphone to simulate the normal and abnormal sounds which would, emanate from the body ERWIN I. scnmnmm.

under healthy or diseased conditions, and blowing into the hollow member istransmitted through the microphone to simulate the sound of heart murmurs. 1

CERTIFICATE OF CORRECTION. Patent No. 2,52 ,169. August 51, 19%.

ERWIN I. SCHINDLER.

It is hereby certified that error appears in the printed specification of the above numbered patent requiring correction as follows: Page 2, first column, line 140, for of first occurrence read -or-;page L second Colline 7, for drosum read -dorsum--; line 10, after the word "phonetics" insert --the-; and that the said Letters Patent should be read with this correction therein that the same may conform to the record of the case in the Patent Office.

Signed and sealed this 19th day of October, A. D. 1914.5.

Henry Van Arsdale, (Seal) Acting Commissioner of Patents 

